Essential Standards for Matriculation, Promotion, and Graduation
I. General Issues
Medical education requires that the accumulation of scientific knowledge be accompanied by the simultaneous development of specific skills and other competencies. Because the Geisel School of Medicine has a responsibility to society to graduate the best possible physicians:
- Admission to Geisel is offered to applicants who present outstanding qualifications for the study and practice of medicine.
- Successfully completing the entire medical school's curriculum is necessary for all students.
- All students must meet both our Academic Standards and Standards for Capacity in order to progress through Geisel and graduate.
Academic Standards refer to acceptable demonstrations of mastery in various disciplines, before matriculation and after, as judged by faculty members, examinations, and other measurements of performance. Acceptable levels of mastery are required in eight broad areas of competency once a student matriculates at Geisel:
- Medical Science
- Clinical Care
- Communication Skills
- Evaluation and Improvement in Medicine
- Collaboration and Teamwork
- Population Health
- Personal, Professional, and Leadership Development
Academic standards, and the related grading systems, are addressed in detail during each course and clerkship. Any student who has specific questions about performance requirements, may speak with course and clerkship directors. Examples accompanying each Standard for Capacity in Section II, however, should provide an accurate sense of expected performance at Geisel.
Standards for Capacity, similar to technical standards, refer to the essential aptitudes and abilities that allow medical students (and physicians) to perform in the vast array of requisite ways summarized by the eight areas of competency above. "Standards for Capacity" may sound unfamiliar, even though the abilities they represent are extremely important in the field of medicine. Those abilities are the foundation for academic success at Geisel, and for the eventual practice of medicine itself. Our Standards for Capacity are described in detail in Section II.
All graduates of the Geisel School of Medicine at Dartmouth must have achieved the eight competencies to function in a wide variety of clinical situations and render a wide spectrum of patient care. Historically, undergraduate medical education in the United States has been structured as a broad general training, which is intended to produce "undifferentiated physicians". Our academic standards and Standards for Capacity are based on that model, and whereas a truly undifferentiated physician may not be achievable, our standards attempt to insure capable, well-rounded future clinicians. *
Without the essential capacities, students cannot fulfill the requirements of all the courses and clerkships at Geisel. Meeting Geisel's Standards for Capacity, as detailed in Section II is, therefore, required for 1) matriculation (insomuch as the abilities can reasonably be determined before matriculation), 2) subsequent promotion from term to term, and 3) graduation from the Geisel School of Medicine.
Reading this document to better understand what is expected at Geisel is important for all applicants and current students.
* This model does not necessarily mean that all Geisel School of Medicine graduates, given their individual strengths and preferences, are equally suited for every postgraduate training program. Instead it means that all graduates have a strong baseline education on which to draw in a wide variety of situations.
It is our experience that a number of individuals with disabilities (as defined by Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, as Amended) are qualified to study and practice medicine with the use of reasonable accommodations. To be qualified for the study of medicine at Geisel, those individuals must be able to meet both our academic standards and the standards for capacity, with or without approved accommodation. Accommodation is viewed as a means of helping students with disabilities meet essential standards, not to circumvent them, and ensure equal opportunity as much as possible.
C. The Use of Auxiliary Aids and Intermediaries
Qualified students with documented disabilities are readily provided with reasonable accommodations at the Geisel School of Medicine, and those accommodations sometimes involve an intermediary or an auxiliary aid. However, no disability can be reasonably accommodated at Geisel with an auxiliary aid or intermediary that provides cognitive support or medical knowledge, substitutes for essential clinical skills, or supplements clinical and ethical judgment. That is to say, accommodations cannot eliminate essential program elements.
Some intermediaries that may be acceptable include sign language interpreters - provided the interpreters offer only translation, and do not perform selective, analytic, interpretive, or integrative functions for the student - or transcriptionists who provide a similar function. In this way, a deaf student is simply enabled to "listen", but is still responsible for essential communication elements of the curriculum. (A deaf student would still need to communicate fluently in written English without an intermediary.) Similarly, a paraplegic student might be able to use aids such as a standing wheelchair or a variable - height table in order to examine a patient.
The faculty believes that visual impairments severe enough to require a scientifically or medically trained intermediary cannot be accommodated at Geisel. Certainly there are advances in technology all the time, and at some point there may be acceptable accommodations for blind students, but an intermediary that would have to select and interpret visual information (e.g. slide configurations, clinical presentations, etc.), would constitute cognitive support and/or a supplement to clinical judgment. This kind of assistance would also, undoubtedly, depend on medical/scientific knowledge to some extent. Use of this type of intermediary would represent a fundamental alteration to the medical program. Reliance on an intermediary trained to perform physical exams for a student with a severe physical disability would also be unacceptable for the same reasons.
II. Geisel School Standards for Capacity
Students at the Geisel School of Medicine at Dartmouth must have capacities/abilities in five broad areas:
- Motor/tactile function
- Professionalism (Mature and Ethical Conduct)
Students must be able to accurately perceive, by the use of senses and mental abilities, the presentation of information through:
- Small group discussions and presentations
- Large-group lectures
- One-on-one interactions
- Laboratory experiments
- Patient encounters (at a distance and close at hand)
- Diagnostic findings
- Written material
- Audiovisual material
Students must be able to communicate skillfully (in English) with faculty members, other members of the healthcare team, patients, families, and other students, in order to:
- Elicit information
- Convey information
- Clarify information
- Create rapport
- Develop therapeutic relationships
- Demonstrate competencies
C. Motor/tactile function
Students must have sufficient motor function and tactile ability to:
- Attend (and participate in) all classes, groups, and activities which are part of the curriculum
- Read and write
- Examine patients
- Do basic laboratory procedures and tests
- Perform diagnostic procedures
- Provide general and emergency patient care
- Function in outpatient, inpatient, and surgical venues
- Perform in a reasonably independent and competent way in sometimes chaotic clinical environments
- Demonstrate competencies
Students must be able to demonstrate higher-level cognitive abilities, which include:
- Rational thought
- Visual-spatial comprehension
- Representation (oral, written, diagrammatic, three dimensional)
- Clinical reasoning
- Ethical reasoning
- Sound judgment
E. Professionalism: (Mature and Ethical Conduct)
Students must be able to:
- Consistently display integrity, honesty, empathy, caring, fairness, respect for self and others, diligence, and dedication
- Promptly complete all assignments and responsibilities attendant to the diagnosis and care of patients (beginning with study in the first year)
- Communicate with, examine, and provide care for all patients—including those whose gender, ethnicity, culture, sexual orientation, or spiritual beliefs are different from students' own
- Develop mature, sensitive, and effective relationships, not only with patients but with all members of the medical school community and healthcare teams
- Maintain sobriety in all academic and clinical environments, and refrain from the illegal use of substances at all times
- Abide by all state, federal, and local laws, as well as all Geisel and Dartmouth-Hitchcock Medical Center codes of conduct
- Tolerate physically, emotionally, and mentally demanding workloads
- Function effectively under stress, and proactively make use of available resources to help maintain both physical and mental health
- Adapt to changing environments, display flexibility, and be able to learn in the face of uncertainty
- Take responsibility for themselves and their behaviors
Any student who has a question about whether he or she can meet these standards should contact Glenda H. Shoop, PhD, MEd at (603) 650-1214 or Glenda.H.Shoop@Dartmouth.edu.
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